Call centers replaced many doctor receptionists. Now comes AI for call centers.

Call centers replaced many doctor receptionists. Now comes AI for call centers.

At a call center in the Philippines, workers help Americans with diabetes or neurological diseases troubleshoot equipment that monitors their health. Sometimes they receive urgent calls: elderly patients who are alone and have a medical emergency.

“This is not part of our staff’s job or our technical support,” said Ruth Elio, a vocational nurse who supervised the center’s workers, when she spoke to KFF Health News last year. “Still, they do it because it’s important.”

Elio also helped workers with their own health problems, most commonly headaches or back pain sustained from a sedentary life for hours on end.

At another call center in the United States, Kevin Asuncion transcribed medical visits from half a world away. You can get used to the hours, he said in an interview last year: 8 p.m. to 5 a.m., his breaks were mostly spent sleeping. Then not much is open.

Health risks and night shifts aside, call center workers have a new concern: artificial intelligence.

Startups are marketing AI products with lifelike voices to schedule or cancel medical visits, refill prescriptions, and help triage patients. Soon, many patients may initiate contact with the healthcare system not by speaking to a call center worker or receptionist, but with AI. Zocdoc, the business appointment company, has launched an automated assistant that says it can schedule visits without human intervention 70% of the time.

The medically focused call center workforce in the Philippines is a large one: 200,000 by the end of 2024, estimates Jack Madrid, the head of the industry trade group. That number is more than the number of paramedics in the United States at the end of 2023, according to the Bureau of Labor Statistics. And some employers are opening outposts in other countries like India and using AI to shape or replace their workforce.

Still, it's unclear whether AI's digital manipulations could match the proverbial human touch. A recent study in Nature Medicine found that while some models can diagnose illnesses when presented with a canned anecdote, like prospective doctors in training, AI has difficulty evoking information from simulated patients.

“The relationship or the trust that we give or the emotions that we have as human beings cannot be replaced,” Elio said.

Sachin Jain, president and CEO of Scan Health Plan, an insurer, said humans have context that AI doesn't have — at least for now. A receptionist in a small practice may know the patients well enough to pick up on subtle clues and communicate to the doctor that a particular caller is "someone you see that day, that minute, or that week that you should talk to."

The pivot toward call centers, while creating more distance between a caller and a healthcare provider, preserved the human touch. But some call center agents and their advocates say the way they are monitored on the job undermines care. At one Kaiser Permanente location, it's a "very micromanaging environment," said a nurse who asked not to give her name for fear of reprisal.

“From the beginning of the shift to the end, you will be expected to take call after call after call from an open queue,” she said. Although he offers advice for complex cases, "there is an unwritten rule about how long a nurse should allow per call: 12 minutes."

In the meantime, the job gets tougher, she said. "We are the backup of the health care system. We are open 24 hours a day," she said. "They're calling for their incision sites, which are bleeding. Your child has asthma, and the medication instructions aren't clear."

A nurses union is protesting against a potential AI management tool in call centers.

“AI tools do not make medical decisions,” Kaiser Permanente spokesman Vincent Staupe told KFF Health News. “Our physicians and care teams are always at the center of decision-making with our patients and in all of our care settings, including call centers.”

Kaiser Permanente is not affiliated with KFF, a nonprofit health information organization that includes KFF Health News.

Some companies report 30% to 50% turnover rates - statistics that some say are turning to AI for handing off work.

Call centers "can't retain people because it's just a really, really challenging job," said Adnan Iqbal, co-founder and CEO of Luma Health, which creates AI products to automate some call center work. No wonder: “If you get yelled at by a patient, an insurance company, an employee, you name it, every 90 seconds?”

To hear business leaders say, their customers are frustrated: Instead of the human touch, patients are getting nothing at all, hampered by long wait times and hidden, disempowered workers.

Once, Marissa Moore — an investor at Omers Ventures — got a taste of patient frustrations when he tried to schedule a visit by phone at five doctors' offices. “In every single one, I got a third party that didn’t have Intel for providers in the office, their availability, or anything.”

These types of handles are becoming more common – and attracting the attention of investors and companies.

Customer complaints affect the commitments of companies - like health insurers, who can be rewarded for better customer service through the federal government's Medicare Advantage policies.

When Scan noticed a decline in patient reviews for some of the medical providers in its insurance network, it learned that those providers had switched to centralized call centers. Customer service suffered and the lower ratings translated into lower payments from the federal government, Jain said.

“There is a level of dissatisfaction that has flared up among our patients,” he said.

For some companies, the notion of a computer receptionist seems to be a welcome solution to the problem of ineffective call centers. AI voices that can convincingly mimic human voices are "beyond the uncanny valley," said Richie Cartwright, the founder of Fella, a weight-loss startup that has used an AI product to call pharmacies and ask if they have GLP-1 supplies in stock.

Prices have also fallen. The price of Google AI has dropped by 97%, claimed Sundar Pichai, the company's CEO, in a 2024 speech.

Some boosters are excited to put the vision of AI assistants into action. Since the second Trump administration, the policy initiatives of Elon Musk's quasi-agency as the Department of Government have reportedly studied artificial intelligence bots for customer service at the Department of Education.

Most executives surveyed by KFF Health News — in the hospital, insurance, engineering and consulting fields — wanted to emphasize that AI would complement humans, not replace them. Some resorted to jargon, claiming the technology could make call center nurses and staff more efficient and effective.

However, some companies are signaling that their AI models could replace human workers. Their websites suggest that trust in staff is reduced. And they are developing pricing strategies based on reducing labor needs, said Michael Yang, a venture capitalist at Omers.

Yang described the prospect for companies as a "we-share-in-the-upside" type of thing, with startups paying customers for the cost of 1½ hires and their AI doing twice as much work.

But providers are currently building narrow services. For example, the University of Arkansas for Medical Sciences started with a limited idea. The organization's call center closes at 5 p.m. - meaning patients who attempt to cancel appointments after hours have left a phone message, creating a backlog for workers who became unrestricted by other scheduling tasks and canceled appointments the next morning. So they used an AI system provided by Luma Health to enable after-hours cancellations and have since expanded it to allow patients to cancel appointments throughout the day.

Michelle Winfeld-Hanrahan, the health system's chief clinical access officer who oversees its deployment, said UAMS has numerous ideas for more automation, including allowing patients to review previous authorizations and guiding them through post-discharge follow-up.

Many executives claim that AI tools can complement rather than replace humans. One company says its product can measure “vocal biomarkers” — subtle changes in tone or inflection — that correlate with disease and provide that information to human workers who interact with the patient. Some companies use large language models to summarize complex documents: document insurance policies or retrieve the necessary information for employees. Others are interested in AI that guides a human through a conversation.

While technology doesn't replace people, it does transform them. AI can be used to change human behavior and presentation. Call center employees said in interviews that they knew about or had heard pervasive rumors or feared a variety of AI tools.

At some Kaiser call centers, organized employees protested — and successfully delayed — the implementation of an AI tool to measure “active listening,” a union flyer claimed.

And employees and executives connected to the call center workforce in the Philippines said they had heard of other software tools, such as technology, that changed Filipino accents to American ones. Given our relatively neutral accents, "there's not a super big need for it, but we've seen that," said Madrid, the trade group's leader.

“Just because something can be automated doesn’t mean it should be,” he said.

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